Provider Demographics
NPI:1326173253
Name:COASTAL COUNSELING ASSOCIATES
Entity Type:Organization
Organization Name:COASTAL COUNSELING ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:PROF
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:FORBES-FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:603-778-0505
Mailing Address - Street 1:24 FRONT ST STE 2
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-2727
Mailing Address - Country:US
Mailing Address - Phone:603-778-0505
Mailing Address - Fax:
Practice Address - Street 1:24 FRONT ST STE 2
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-2727
Practice Address - Country:US
Practice Address - Phone:603-778-0505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH136101YM0800X
NH951041C0700X
NH6061041C0700X
NH941041C0700X
NH2451041C0700X
NH1881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30009700Medicaid
NHRE4250Medicare ID - Type UnspecifiedGROUP PSYCHIATRISTS
NHRE4251Medicare ID - Type UnspecifiedGROUP THERAPIST